Combatting Postcode Lottery: A Qualitative Exploration of Staff Perspectives on Rural Surgical Outreach Clinics in Hawke's Bay, Aotearoa New Zealand.

Abstract

Background: Rural communities in Aotearoa New Zealand experience inequitable access to surgical care. Rural surgical outreach clinics aim to reduce geographic and financial barriers by delivering specialist care closer to patients. Healthcare professionals' perspectives on the functioning, value and sustainability of these services remain underexplored.

Methods: A qualitative descriptive study was conducted using semi-structured interviews with nine staff members (consultant surgeons, nurses, junior doctors and administrative staff) purposively sampled from general surgical outreach clinics in Waipukurau and Wairoa, Hawke's Bay, Aotearoa New Zealand. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.

Results: Five interconnected themes were identified: (1) bringing care to the people-outreach as equity in action; (2) reducing the hidden costs of care; (3) relationships, cultural safety and trust; (4) staff as agents of change and rural outreach champions; and (5) the fragility and sustainability of outreach services. Participants perceived outreach clinics as improving access to specialist care, reducing the practical and financial burden of travel for patients, strengthening relationships with rural and Māori patients and enhancing team cohesion and professional fulfilment. However, outreach services were seen as vulnerable to resource constraints, centralised booking processes, reliance on committed individuals and policy pressures favouring centralisation.

Conclusion: Rural surgical outreach clinics form part of a rural and regional model of healthcare that mitigates barriers for patients and the wider health system. Sustaining and scaling these services will require deliberate institutional support and appropriate resourcing.